Epilepsy/Seizures

Epilepsy/Seizures

What is a seizure?
A chemical imbalance or structural abnormality in the brain can result in abnormal electrical activity that results in clinical symptoms called seizures. The symptoms depend on the part of the brain involved falling along a spectrum ranging from mild sensory symptoms, staring spells, confusional spells, motor movements, generalized convulsions, and more. Seizures may be provoked by general systemic conditions or may be part of a disorder known as epilepsy.

What is epilepsy?
Epilepsy is the occurrence of two or more seizures in a person which has not been provoked by other systemic illnesses or circumstances. Epilepsy is a fairly common condition which occurs in 0.5% to 1% of the population. Epilepsy is a very treatable condition and many patients with epilepsy can live relatively normal lives.

What are epilepsy medications?
Epilepsy medications are used to suppress the electrical activity in the brain to prevent seizures. There is a long list of epilepsy medications which have been designed and created over the last century. Some medications are ideal for certain seizure types while others have a broader spectrum of utility. Seizure medications are often picked based on the seizure type, the presence of other diseases, side effects, and cost.

What is intractable epilepsy?
When a patient who has epilepsy has been compliant on two or more seizure medications and their seizures remain uncontrolled that patient is said to have intractable epilepsy. Occasionally a patient who is thought to have intractable epilepsy may actually have other conditions that mimic seizures which are why the medications were not working. These patients need to be evaluated in an epilepsy monitoring unit to confirm their seizure type or the possibility of an alternative diagnosis. Once a patient has been confirmed to have epilepsy which is originating from a specific part of the brain and that this epilepsy is intractable they may be considered for epilepsy surgery.

What is epilepsy surgery?
Epilepsy surgery involves evaluation for localization of a seizure focus in a patient who has intractable epilepsy. Once we are able to see that the focus is localized the patient is further evaluated to see if there is any eloquent or important brain function in that region. If that part of the brain is confirmed through careful testing to have very little function, it can often be safely removed. The success of epilepsy surgery has varied from 40% to 90% in different patient populations. Evaluation for epilepsy surgery does not require a patient to go on and have surgery and not all patients who are evaluated are found to be surgical candidates. Other surgical implanted devices are being used to reduce the frequency of seizures such as vagal nerve stimulator’s, deep brain stimulators, and cortical stimulators when intractable patients are found to not be surgical candidates.

How do I know if I am epilepsy surgery candidate?
Patients who have intractable epilepsy localized to a specific focus in the brain may be a candidate for epilepsy surgery. Careful evaluation of a patient’s history, imaging, and electroencephalograms by an experienced epileptologist is necessary for conjunction with a neurosurgical evaluation. Epilepsy surgery is not taken lightly and involves a team approach to the patient involving a well-trained epileptologist, neurosurgeon, psychologist, technicians involved with patient monitoring, and many other support staff.

What else needs to be considered when treating epilepsy?
Apart from surgery and medications, epilepsy care also involves addressing issues such as employment, ability to travel, safety, cognitive slowing due to disease or medications themselves, and financial constraints. Each patient is an individual and their care should be carefully discussed with his or her physician and no one treatment is universal for all.

What do I do if my family member has a seizure?
Make sure the patient’s airway is clear by laying them on their side and lean them forward so if anything is in their mouth it wall fall out. Make sure they’re in a place where they will not get hurt and move items that may injure them away from them. There is no reason to put anything in the mouth of a patient having a seizure and this has been shown to be dangerous. If your loved one is known to have epilepsy and you are familiar with your loved one’s spells you should call 911 in the following circumstances: he or she has a seizure that lasts more than two minutes, has repeated back to back seizures, is not waking up from the spell, shows any difficulty with breathing, or you feel unsure of the circumstances. For a patient who has never had a seizure before, call 911 right away.

Women who have epilepsy.
Careful consideration of epilepsy medication should be given in any woman in her reproductive years. The seizure disorder and or the medications can have an effect on a fetus or breastfeeding baby and medications should ideally be adjusted prior to pregnancy. Most women with epilepsy are able to have normal children with careful guidance.

What is brain mapping?
Brain mapping is the process by which abnormal seizure foci of the brain are localized and normal function is localized as well. Noninvasive brain mapping begins with a careful history and physical exam and includes neuropsychological evaluations, MRI, CT, SPECT scan, functional MRI, and rarely Magnetoencephalography. More invasive procedures may be necessary such as Wada evaluations and direct brain recordings and stimulations.